FARMASI KOTA BEKASI

LAMPIRAN STOK OPNAME OBAT PER 30 NOVEMBER 2018

UPTD PUSKEMAS KRANJI

NO NAMA OBAT SATUAN JUMLAH ED

1 2 3 4 5
A. OBAT-OBATAN

1 Acetylcystein Tablet 2,380 Jun-20

2 Albendazol tab 400 mg Tablet 450
3 Alopurinol tablet 100 mg tablet 1,750 Apr-21
4 Alopurinol tablet 300 mg tablet

5 Ambroksol sirup 15 mg/ 5 ml btl/60 ml 350 Oct-20

6 Ambroksol tablet 30 mg tablet

7 Amitriptilin 25 tab tablet

8 Amlodipin tablet 10 mg tablet 1,520 Apr-20

9 Amlodipin tablet 5 mg tablet 1,320 Apr-20
10 Amoksisilin Kaplet 500 mg tablet 14,100 May-21
11 Amoksisilin Kapsul 250 mg kapsul 1,032 Mar-20
12 Amoksisilin Sirup Kering 125 mg/5 ml btl/60 ml 312 Mar-19
13 Amoksisilin Forte Dry 250 mg sirup btl/60 ml

14 Antasida DOEN I tab kunyah, kombinasi: Alu tablet 2,270 Jul-19

15 Antasida DOEN II suspensi, kombinasi: btl/60 ml 154 Apr-19
16 Anti diare tablet (New Antides ) tablet 1,170 Mar-21
17 Anti Hemmoroid supp 70
18 Antidiare suspensi (Antamen) Btl/60 ml

19 Asam asetil salisilat 80 mg/Miniaspi tablet 450 Feb-21

20 Asam Askorbat (Vit C) tablet 250 mg tablet 1,540 Mar-19
21 Asam mefenamat 500 mg tablet 3,990 May-20
22 Asam Folat 0,4 mg tablet 2,800 Mar-19
23 Asiklovir Krim 5%- 5 g tube 59 Oct-20
24 Asiklovir tab 200 mg tablet 1,530 Feb-22
25 Asiklovir tab 400 mg tablet 1,040 Aug-21
26 Azitromisin 500 mg tablet

27 Betahistin mesilat tab 6 mg Tablet

28 Betametason Krim 0,1 % tube 75 Nov-19

29 Bisakodil supp. 5 mg suppo

30 Bisakodil tab. 5 mg Tablet

31 Boraks Gliserin Btl/10ml

32 Cendo lyteers 15 ml Btl/15 ml

Cendo Lyters/Kombinasi Tetes Mata 2,5 mg/ml

33 btl

34 Cendo Pantocain 5 ml btl/5 ml

35 Cetirizine 10 mg tablet 1,410 Apr-20

36 Cetirizine 10 mg tablet

37 Cetirizin sirup5mg/5ml Btl/60 ml

38 Deksametason tablet 0,5 mg tablet 14,500 Mar-20

39 Diazepam tablet 2 mg tablet 124
40 Diazepam rectal 5 mg tube

41 Dietil Karbamazin tab tablet

42 Digoksin tab 0,25 mg Tablet

43 Doksisiklin kaps 100 mg kaps 360 May-20

44 Domperidon susp 5 mg/5 ml botol 130 Apr-21
45 Domperidon tab 10 mg tablet 449 Sep-20
Eritromisin kaps/kaplet 500 mg kapsul
46 470 Sep-20
47 Eritromisin sirup 200 mg/5 ml btl/60 ml

48 Fenobarbital 30 mg tablet 1,100 Apr-20

 FARMASI KOTA BEKASI

NO NAMA OBAT SATUAN JUMLAH ED

49
Fenol Gliserol tetes telinga 10% botol 33

50
Fitomenadion (Vit K1) tab sal gula 10 mg tablet 700 Dec-20
51 Flukonazole 150 mg tablet

52 Furosemid Tablet 40 mg tablet 300 Feb-21

53 Garam oralit I serbuk kombinasi sachet 344
Gentamisin salep kulit 0,1% Tube@ 5 gr
54 152 Sep-20
55 Glibenklamid tablet 5 mg tablet 390 Aug-21
56 Glimepiride 2 mg tablet 270 Jan-21
57 Gliseril Guayakolat Tablet 100 mg Tablet 940
Glukosa larutan Infus 5 % Btl/500 ml
58
tablet
59 Griseofulvin tablet 125 mg, micronized 155
60 Haloperidol tab. 5 mg tablet
Hidroklortiazid tab (HCT) tab 25 mg tab
61

62 Hidrokortison Krim 2,5 % - 5 g tube 163 May-21

63 Hidrokortison Krim 1 % - 5 g tube

64 Hyosin Butilbromid Tab 10 mg/ Scopma tablet

65 Ibuprofen 200 mg tablet 740

66 Ibuprofen 400 mg tablet

67 Ibuprofen suspensi 100 mg/5 ml btl/60 ml

68 Ichtyol salep 10% Pot 15g 34 Oct-22

69 Isoniazida 100 mg Tablet tablet 321 Mar-20
tablet
70 Isosorbid Dinitrat tab sublingual 5 mg 100 Mar-20
71 Kalsium Laktat tab 500 mg tablet 5,200 Apr-20
72 Kaptopril 12,5 mg tablet 440 Sep-19
73 Ketokonazol tab 200 mg tablet 250 Jul-21
74 Ketoprofen suppos 100 mg suppo 10
75 Klindamisin kaps 300 mg kapsul

76 Kloramfenikol salep mata 1% Tube 5g 85

77 Kloramfenikol kap 250 mg kapsul 840 Jul-21
78 Kloramfenikol Tetes Mata Btl

79 Kloramfenikol Tetes Telinga 1% Btl 22

Kloramfenikol 20 mg dan prednisolon 2,5mg salep
80 kulit/Klorfeson Tube 5g 138 Jul-20
81 Kloramfenikol suspensi 125 mg/5 ml btl 38 May-19
82 Klorfeniramin Maleat (CTM) Tablet 4 mg tablet 10,320
83 Klorpromazin tab. 25 mg tablet

84 Kodein tab. 10 mg tab 120 Dec-19

85 Kotrimoksazol suspensi : Kombinasi btl/60 ml 180 Aug-20

tablet
86 Kotrimoksazol tab DOEN I (dewasa) kombinasi 2,780 May-21
87 Loratadin Tablet

88 Metformin tab. 500 mg tablet 1,360 May-20

89 Metilergometrin maleat tab salut 0,125 mg Tablet

90 Metilprednisolon tab. 4mg Tablet 480 May-21

91 Metronidazol tab 500 mg Tablet 300 Jul-19
92 Metronidazol tab 250 mg Tablet 1,015 Apr-21
93 Mikonazol krim 2% (nitrat) Tube 10g 120 Apr-21
94 Multivitamin sirup/ Biovitan Btl/60 ml 165 Nov-19
95 Multivitamin tablet Tab 2,830 Jun-20
Natrium Bikarbonat tab 500 mg Tablet
96
Natrium Diklofenak tab 50 mg tablet
97 4,250 Jan-20
Natrium Klorida larutan infus 0,9% Btl/ 500 ml
98

99 Nifedipin tab 10 mg tablet

Nistatin Vaginal Tab 100.000 IU tabvag
100 171
Nistatin drop 100.000 IU/ml suspensi Btl/12ml
101 11 May-20
102 OAT FDC Kategori Anak Paket 1 Jun-19
 FARMASI KOTA BEKASI

NO NAMA OBAT SATUAN JUMLAH ED

103 OAT FDC Kategori I paket 5 Mar-21

104 OAT FDC Kategori II Paket 2
Obat Antiinfluensa tab dewasa (kombinasi tab
paracetamol, fenilpropanolamin dan
ctm)/MOLEXFLU
105
Obat Batuk Herbal mengandung : zingiberis Btl/100 ml
Offinale rhizoma,/zingeberis Rhizoma/HERBAKOF
106 144 Jul-19
btl/60 ml 180
Obat batuk kombinasi untuk anak (kombinasi
107 paracetamol, GG dan ctm) Sep-20
Blister 2
108 Obat Kusta MB Anak

109 Obat Kusta MB Dewasa

Blister 6 Mar-21
Blister
110 Obat Kusta PB Anak

111 Oksitetrasiklin HCl salep mata 1% Tube 3,5g 59 Sep-20

112 Oksitetrasiklin salep kulit 3% Tube 5g

113 Omeprazol Kaps 20 mg Kapsul 990

Parasetamol sirup 120 mg/5 ml btl/60 ml
114 307 Nov-19
115 Paracetamol drops 10 mg/ml Btl/15 ml 112 Jun-19
116 Paracetamol suppos 125 mg ktk/dus

117 Parasetamol tablet 500 mg tablet 19,300 Apr-19

118 Pirantel tab 125 mg tablet
Piridoksin (Vit B 6) tablet 10 mg tablet
119 3,600
Polikresulen ( Kondensasi Metakresol Sulfonat dan Btl/10 ml
Metanal) 360 mg/g
120

121 Prednison Tablet 5 mg tablet 1,190 Jun-19

122 Propanolol tab 10 mg (HCl) Tablet

123 Ranitidin tab. 150 mg tablet 5,000 Mar-19

124 Retinol (Vit A) 100.000 IU Kaps lunak Kapsul 560
125 Retinol (Vit.A) 200.000 IU Kaps lunak kapsul 375
126 Ringer Laktat Larutan Infus Steril Btl/ 500 ml

127 Salbutamol 2 mg tablet 2,430 Feb-20

128 Salbutamol tablet 4 mg tablet
Salep 2-4 , kombinasi : Asam salisilat 2% + Pot
Belerang endap 4%
129 44 Oct-19
Salep luka bakar/levertran Pot 15g
130 39 Sep-20
Salisil Bedak 2% Kotak 50 gr
131 180 Aug-20
132 Sefiksim 100 mg Kapsul

133 Sianokobalamin (Vit. B12) tab. 50 mcg tablet 3,540 Jun-22

134 Simvastatin tablet 10 mg tablet 1,200 Apr-20
135 Siprofloksasin tablet 500 mg tablet 1,260 Apr-20
136 Scabimite cream 5% 10 gr tube 5 Oct-21
Tablet tambah Darah kombinasi (Besi II sulfat 200 Tablet
mg + Asam folat 0,25 mg)(Ferro folat)

137 2,110 May-19

Tiamin HCl/Nitrat (Vit B1) tab 50 mg tablet
138 2,730 Mar-21
139 Tiamfenikol kap 500 mg Kapsul 1,580 Sep-20
 FARMASI KOTA BEKASI

NO NAMA OBAT SATUAN JUMLAH ED

140 Triamsinolon oral base krem 5 g Tube 5 g 9

141 Trihexipenidil tab. 2mg Tablet

142 Vitamin B kompleks tablet tablet 9,700 Mar-20

143 Zink tab 20 mg tablet 360 Feb-19
144 Zink sir 20 mg/5 ml / ZIRKUM btl/60 ml 150 Mar-19
Anti Koagulan Topical gel Tube 10 gr
145

146 Sendok obat buah 223

B.OBAT INJEKSI

1 Asam Traneksamat 5% injeksi vial

2 Atropin injeksi ampul

3 Benzatin Benzil Penisilin injeksi vial

4 Budesonid 0,25 mg/ml / PULMICORT respules

5 Deksametason inj 5 mg/ml ampul 105

6 Epinefrina (adrenalin) injeksi 0,1% (sbg HCl) Ampul 5

Fitomenadion (Vit K1) Injeksi 10 mg/ ml- 1 ml ampul

7

8 Glukosa kalsikus injeksi 10% Ampul

9 Hyosina N. Butilbromida 20 mg/ml Ampul

10 Lidocain inj 2 % ampul

11 Lidokain Komp. Injeksi, Kombinasi: Ampul 20

Metilergometrin Maleat injeksi 0,200mg-1 ml Ampul

12

13 Magnesium sulfat injeksi 20% Vial

14 Ranitidin inj. 25mg/2 ml Ampul

15 Salbutamol cairan inhalasi 0,1% ampul/2,5 ml

16 Oksitosin injeksi ampul/2,5 ml

Ipratropium br 0,5 mg+ salbutamol 2,5 mg inhalasi

/COMBIVENT
17 vial

C.OBAT LUAR
1
Etakridin (Rivanol) larutan 0,1 % Btl/300 ml 5
2 Etanol 70 % Btl/1000 ml 4 Oct-20
3 Hidrogen peroksida 3% Btl/1000 ml
4 tube
Jelly 80 g untuk USG/Doppler
5 Lisol mengandung Kresol Tersabun 50% Btl/1000 ml 8 Feb-20
6 Povidon Iodida 10% Btl/60 ml 3
7 Xylocain Jelly 2% tube 1

D.OBAT GIGI
1 Articulating paper I/Hanel Articulating KTK/12X12
Paper
 FARMASI KOTA BEKASI

NO NAMA OBAT SATUAN JUMLAH ED

2 Devitalisasi pasta btl 2

3
Eugenol cairan 2
Endo-Frost (bahan dasar butan,propan,iso Botol/set @
4 butan) 200 gr 3 Aug-22
5 Glass Ionomer Cement ART (GC-IX)/ Fuji IX Botol/ 10 g 3
6 Kalsium hidroksida pasta 2tube/ktk
7 Klorfenol Kamfer Mentol (CHKM) Btl/10 ml

8 Mummyfying pasta Btl

9
Semen seng fosfar serbuk dan cair set 3
Temporary Stopping Fletcher (Fletcher) Botol/set @
10 Serbuk 100 gr

E. VAKSIN
Vaksin Hepatitis HBsAg 10 mcg, Al 0,25
1 mg, Thimerosal 0,01% w/v vial
Vaksin jerap difteri tetanus (DT) inj 40/15
2 If per ml (i.m) vial 15
Vaksin jerap difteri tetanus (Td) inj 4/15 If
3 per ml (i.m) 944

4 Vaksin kombinasi DPT-HB-Hib inj (i.m)

Vaksin Measles & Rubella (MR) inj 0,5 mL
5 (sc) 79
6 Vaksin Polio b-OPV drops 10 dosis (i.m) 16
Vaksin BCG serb inj 0,75 mg/mL pelarut
7 (i.k) 93

F. TAMBAHAN

TOTAL OBAT

Bekasi,

Pengelola Obat Kepala Puskesmas

..................................... .....................................
NIP. ................................... NIP. ...........................................
 PKM AREN JAYA 6

LAMPIRAN STOK OPNAME BMHP PER 30 NOVEMBER 2018

UPTD PUSKESMAS KRANJI

NO NAMA BARANG SATUAN JUMLAH ED

1 2 3 4 5
A. BAHAN HABIS PAKAI
1 Abbocath (IV cateter no. 20 G x 1 1/4") Set
2 Abbocath no 20 (Sterracath) Set
3 Abbocath no 22 (Sterracath) Set
4 Abbocath no 24 Set
5 Alat Suntik sekali pakai 0,05 ml set
6 Alat Suntik sekali pakai 0,5 ml set 3,000
7 Alat Suntik Sekali Pakai 1 ml (Stera 1 cc
Tuberculin 27G x 1/2 ") set 150 Apr-22
8 Alat Suntik Sekali Pakai 3 ml(Stera 3 cc x 23G x 1
1/4 ") set 200 Oct-21
9 Alat Suntik sekali pakai 5 ml Set 150
10 Alkohol Swab set
11 Box Slide, kapasitas 100 buah
12 Cat Gut Plain 3/0 + jarum 1/2 GT 35 mm set
13 Catgut/benag bedah No. 2/0 Set
14 Catgut/benag bedah No. 2/0 chrom Set
15 Foley cateter two way No. 18 Buah
16 Infusion set Anak set/ktg
17 Infusion set dewasa (20 drops/ml) set 3
18 Kasa pembalut/absorben 250 mg Roll 7
19 Kasa kompres 40/40 steril Buah 5
20 Kasa pembalut Hydrofil 4 x 15 cm Roll
21 Kasa pembalut Hydrofil 4 x 3 cm Roll 18
22 Kassa Hidrofil 40 m x 80 cm Roll
23 Kassa Hidrofil steril 16 x 16 Ktk 20
24 Kassa Pembalut 2 m x 80 cm Roll 2
25 Kassa Pembalut Hidrofil 4 m x 5 cm Roll 1
26 Kassa Pembalut Hidrofil 4 m x 10 cm Roll
27 Plester 0,5 inc x 5 yard Roll 1
28 Object Glass frosted buah 20
29 Safety box Buah 300
30 Pot dahak Buah 250
31 Surgical Mask-plus 3 Ply Plus Earloop Buah 350
32 Silk (benang bedah sutra) no.3.0 set
33 Sarung tangan examination (M) Pasang 150
34 Sarung tangan examination (S) Pasang 600
35 Umbilical buah
36 Tule Dessing (Cuticell Classic) 10x10 Buah

37 Dressing Antimicroba (Cutimed Sorbact 7x9 cm) Buah

38 Dressing Fiksasi (Fixomull Stech) 10cm x 5 m Buah

39 IV-catheter no.18 (aximed) Buah
40 Aximed Paper tape 1,25cm x 9,14 m Buah 2
41 Pot Urine Buah
42 Masker N 95 Buah
43 Urobag Buah
44 Blood lancet 28 G Buah
45 ST.Gynaecolog steril Pasang
46 Sound timer buah
47 Venoject EDTA Buah

B.REAGEN
1 Reagen TB / Zeil Nelsen Kit/100 ml
2 Reagen Syphilis Ktk/20 test
3 HIV 2 (Intec) Kit /100 tes
4 HIV 2 (Oncoprobe) Kit/50 tes
5 HIV 1 (SD) Kit /100 tes 2
6 HIV 1 (SD) Kit /100 tes
7 Anaskopi Unit
8 Rotator Unit
9 CD 4 Control Tes
10 Alat Deteksi resiko Kehamilan (ADRK) Paket 4
 PKM AREN JAYA 7

NO NAMA BARANG SATUAN JUMLAH ED

B.TAMBAHAN

Bekasi,

Pengelola Obat Kepala Puskesmas

.................................................. ....................................
NIP. .................................... NIP. ...................................
 DAFTAR USULAN KEBUTUHAN BMHP TAHUN 2019
UPTD PUSKESMAS

KEBUTUHAN KEBUTUHAN
NO NAMA BARANG SATUAN HARGA SATUAN TOTAL HARGA
PERBULAN SETAHUN (15 Bl)
1 2 3 4 5 6=5*15bln 7=6*5
A. BAHAN HABIS PAKAI
Alat Suntik Sekali Pakai 1 ml (Stera 1 cc
1 Tuberculin 27G x 1/2 ") set 689.86 88 1,320 910,615.20
Alat Suntik Sekali Pakai 3 ml(Stera 3 cc
2 x 23G x 1 1/4 ") set 669.80 67 1,005 673,149.00
3 Alat Suntik sekali pakai 5 ml Set 968.00 107 1,605 1,553,640.00
4 Alat Suntik sekali pakai 0,05 ml set 1,750.00 200 3,000 5,250,000.00
5 Alat Suntik sekali pakai 0,5 ml set 1,845.50 4,483 67,245 124,100,647.50
6 IV cateter No.18 Set 6,000.00 - -
7 IV cateter No.20 Set 6,000.00 - -
8 IV cateter No.22 Set 6,000.00 - -
9 IV cateter No.24 Set 6,000.00 - -
10 Alkohol Swab set 100.00 310 4,650 465,000.00
11 Blood lancet 28 G Buah 145.66 - -
12 Catgut plain 2/0 cromic Set 5,583.33 2 30 167,499.90
13 Catgut plain 3/0 cromic Set 5,583.33 2 30 167,499.90
14 Catgut Cromic 3/0 plain Set 5,583.33 - -
15 Foley cateter two way No. 18 Buah 8,000.00 - -
16 Infusion set Anak set/ktg 5,100.00 1 15 76,500.00
17 Infusion set dewasa set 4,800.00 1 15 72,000.00
18 Jarum/needle 24 -
19 Kasa pembalut/absorben 250 mg Roll 12,500.00 3 45 562,500.00
20 Kassa Hidrofil steril 16 x 16 Ktk 8,000.00 3 45 360,000.00
21 Kasa kompres 40/40 steril Buah 1,600.00 2 30 48,000.00
22 Kassa Pembalut Hidrofil 4 m x 5 cm Roll 750.00 2 30 22,500.00
23 Kassa Pembalut Hidrofil 4 m x 10 cm Roll 1,552.14 2 30 46,564.20
24 Pot dahak Buah 2,728.00 128 1,920 5,237,760.00
25 Pot Urine Buah 2,331.00 - -
26 Masker 3 Ply Plus Earloop Buah 440.00 400 6,000 2,640,000.00
27 Sarung tangan examination (M) Pasang 712.40 83 1,245 886,938.00
28 Sarung tangan examination (S) Pasang 712.40 260 3,900 2,778,360.00
29 Silk (benang bedah sutra) no.3.0 set 4,583.33 - -
30 sarung tangan obgin Pasang 19,360.00 3 45 871,200.00
31 Umbilical buah 1,325.60 - -
32 Tule Dessing (Cuticell Classic) 10x10 Buah 5,198.00 - -
Dressing Antimicroba (Cutimed
33 Sorbact 7x9 cm) Buah 31,756.00 - -
Dressing Fiksasi (Fixomull Stech) 10cm
34 x5m Buah 70,903.00 - -
35 Micropor Buah 10,953.08 - -
36 Masker N 95 Buah 6,512.00 - -
37 Urinbag Buah 5,808.00 - -
38 Wing needle no 21 Buah - -
39 Wing needle no 25 Buah - -

TOTAL BMHP (RP) 146,890,373.70

Bekasi, ......................
Mengetahui
Pengelola Obat Kepala Puskesmas

........................................ ...................................
NIP. ...................................... NIP. .........................
 DAFTAR USULAN KEBUTUHAN OBAT-OBATAN TAHUN 2019
UPTD PUSKESMAS KRANJI

KEBUTUHAN KEBUTUHAN
NAMA OBAT SATUAN HARGA SATUAN PERBULAN SETAHUN (15 Bl) TOTAL HARGA

1 2 3 4 5 6=5*15bln 7=6*5
I OBAT-OBATAN E KATALOG
1 Acetylcystein Tablet 358.00 260 3,900 1,396,200.00
2 Albendazol tab 400 mg Tablet 403.00 - -
3 Alopurinol tablet 100 mg Tablet 99.00 640 9,600 950,400.00
4 Alopurinol tablet 300 mg tablet 210.00 483 7,245 1,521,450.00
5 Amitriptilin 25 tab tablet 167.00 - -
6 Amlodipin tablet 10 mg tablet 70.00 1,030 15,450 1,081,500.00
7 Amlodipin tablet 5 mg tablet 93.00 1,012 15,180 1,411,740.00
8 Amoksisilin Kaplet 500 mg Tablet 232.00 4,844 72,660 16,857,120.00
9 Amoksisilin Kapsul 250 mg kaps 184.00 1,535 23,025 4,236,600.00
10 Amoksisilin Sirup Kering 125 mg/5 ml btl/60 ml 2,000.00 181 2,715 5,430,000.00
11 Amoksisilin Forte Dry 250 mg sirup btl/60 ml 3,400.00 53 795 2,703,000.00
12 Antasida DOEN I tab kunyah, kombinasi: Alu tablet 54.00 2,040 30,600 1,652,400.00

13 Antasida DOEN II suspensi, kombinasi: btl/60 ml 1,995.00 32 480 957,600.00

14 Anti diare tablet /Attalpugit tablet 136.00 793 11,895 1,617,720.00
15 Anti Hemmoroid supp suppo 3,167.00 42 630 1,995,210.00
16 Antimigren : Ergotamin Tartrat 1 mg + Kafein tablet 173.00 - -
50 mg
17 Asam asetil salisilat 80 mg/Miniaspi tablet 114.00 - -
18 Asam Askorbat (Vit C) tablet 50 mg tablet 105.00 353 5,295 555,975.00
19 Asam mefenamat 500 mg tablet 103.00 2,442 36,630 3,772,890.00
20 Asam Folat 0,4 tablet 52.00 733 10,995 571,740.00
21 Asiklovir tab 200 mg tablet 358.00 361 5,415 1,938,570.00
22 Asiklovir tab 400 mg tablet 380.00 254 3,810 1,447,800.00
23 Azitromisin 500 mg (untuk program) tablet 1,778.00 - -
24 Betahistin mesilat tab 6 mg Tablet 110.00 - -
25 Betametason Krim 0,1 % tube 1,340.00 56 840 1,125,600.00
26 Bisakodil supp. 5 mg tablet 6,000.00 - -
27 Cendo lyteers 15 ml Btl/15 ml 19,125.00 2 30 573,750.00
28 Cendo Pantocain 5 ml btl/5 ml 11,500.00 1 15 172,500.00
29 Cetirizine 10 mg tablet 90.00 172 2,580 232,200.00
30 Cetirizin sirup5mg/5ml Btl/60 ml 2,850.00 - -
31 Deksametason tablet 0,5 mg tablet 32.00 5,531 82,965 2,654,880.00
32 Diazepam tablet 2 mg tablet 86.00 30 450 38,700.00
33 Diazepam rectal 5 mg tube 12,573.00 3 45 565,785.00
34 Dietil Karbamazin tab (untuk program) tablet 138.00 - -
35 Digoksin tab 0,25 mg Tablet 104.00 - -
36 Doksisiklin kaps 100 mg kaps 264.00 76 1,140 300,960.00
37 Domperidon susp 5 mg/5 ml botol 2,700.00 33 495 1,336,500.00
38 Domperidon tab 10 mg tablet 85.00 125 1,875 159,375.00
39 Eritromisin kaps/kaplet 500 mg kapsul 750.00 257 3,855 2,891,250.00
40 Eritromisin sirup 200 mg/5 ml btl/60 ml 6,090.00 30 450 2,740,500.00
41 Fenobarbital 30 mg tablet 171.00 25 375 64,125.00
42 Fenol Gliserol tetes telinga 10% botol 2,590.00 15 225 582,750.00
43 Fitomenadion (Vit K1) tab sal gula 10 mg tablet 710.00 188 2,820 2,002,200.00
44 Flukonazole 150 mg (untuk program) tablet 18,720.00 - -
45 Furosemid Tablet 40 mg tablet 77.00 25 375 28,875.00
46 Garam oralit I serbuk kombinasi sachet 257.00 279 4,185 1,075,545.00
47 Gentamisin tetes Mata 0,3% Btl 4,232.00 25 375
48 Glibenklamid tablet 5 mg tablet 119.00 68 1,020 121,380.00
49 Glimepiride 2 mg tablet 207.00 137 2,055 425,385.00
50 Glukosa larutan Infus 5 % Btl/500 ml 6,900.00 - -
51 Greseofulvin 125mg tablet Tablet 849.00 23 345 292,905.00
52 Haloperidol tab. 5 mg tablet 56.00 - -
53 Hidroklortiazid tab (HCT) tab 25 mg tab 149.00 - -
54 Hidrokortison Krim 2,5 % - 5 g tube 2,650.00 69 1,035 2,742,750.00
55 Hidrokortison Krim 1 % - 5 g tube 3,055.00 - -
56 Ibuprofen 200 mg tablet 105.00 187 2,805 294,525.00
57 Ibuprofen 400 mg tablet 127.00 - -
58 Isoniazida 100 mg Tablet tablet 72.00 90 1,350 97,200.00
59 Isosorbid Dinitrat tab sublingual 5 mg tablet 89.00 20 300 26,700.00
60 Kalsium Laktat tab 500 mg tablet 59.00 1,320 19,800 1,168,200.00
61 Kaptopril 12,5 mg tablet 59.00 131 1,965 115,935.00
62 Kaptopril 25 mg tablet 75.00 117 1,755 131,625.00
63 Ketokonazol tab 200 mg tablet 270.00 20 300 81,000.00
64 Ketoprofen suppos 100 mg suppo 2,380.00 - -
65 Klindamisin kaps 300 mg kapsul 715.00 - -
 KEBUTUHAN KEBUTUHAN
NAMA OBAT SATUAN HARGA SATUAN PERBULAN SETAHUN (15 Bl) TOTAL HARGA

1 2 3 4 5 6=5*15bln 7=6*5
66 Kloramfenikol kap 250 mg kapsul 310.00 185 2,775 860,250.00
67 Kloramfenikol SK Tube@ 5 gr 3,038.00 60 900 2,734,200.00

68 Kloramfenikol Tetes Mata 0,5% Btl 3,251.17 58 870 2,828,517.90

69 Kloramfenikol Salep Mata 1% Tube 5g 1,881.00 30 450 846,450.00
70 Kloramfenikol Salep Kulit Tube 5g -
71 Kloramfenikol suspensi 125 mg/5 ml btl 4,700.00 6 90 423,000.00
72 Klorfeniramin Maleat (CTM) Tablet 4 mg tablet 22.00 4,445 66,675 1,466,850.00
73 Klorpromazin tab. 25 mg tablet 147.00 - -
74 Kodein tab. 10 mg tab 571.00 40 600 342,600.00
75 Kotrimoksazol suspensi : Kombinasi btl/60 ml 2,052.00 73 1,095 2,246,940.00
76 Kotrimoksazol tab DOEN I (dewasa) tablet 125.00 1,098 16,470 2,058,750.00
kombinasi

77 Loratadine tablet 123.00 - -

78 Metformin tab. 500 mg tablet 96.00 614 9,210 884,160.00
79 Metilergometrin maleat tab salut 0,125 mg Tablet 210.00 - -

80 Metilprednisolon tab. 4mg Tablet 134.00 365 5,475 733,650.00

81 Metronidazol tab 500 mg Tablet 124.00 100 1,500 186,000.00
82 Metronidazol tab 250 mg Tablet 89.00 82 1,230 109,470.00
83 Mikonazol krim 2% (nitrat) Tube 10g 3,414.00 64 960 3,277,440.00
84 Natrium Diklofenak tab 50 mg tablet 115.00 2,692 40,380 4,643,700.00
85 Natrium Klorida larutan infus 0,9% Btl/ 500 ml 6,410.00 - -
86 Nistatin Vaginal Tab 100.000 IU tabvag 560.00 34 510 285,600.00
87 Nistatin drop 100.000 IU/ml suspensi Btl/12ml 13,500.00 7 105 1,417,500.00
88 OAT FDC Kategori Anak Paket 232,518.00 1 15 3,487,770.00
89 OAT FDC Kategori I paket 389,344.00 4 60 23,360,640.00
90 OAT FDC Kategori II Paket 1,297,889.00 1 15 19,468,335.00
91 Obat Kusta MB Anak Blister 20,207.00 3 45 909,315.00
92 Obat Kusta MB Dewasa Blister 28,424.00 4 60 1,705,440.00
93 Obat Kusta PB Anak Blister 8,712.00 - -
94 Obat Kusta PB Dewasa Blister 27,852.00 1 15 417,780.00
95 Oksitetrasiklin HCl salep mata 1% Tube 3,5g 2,500.00 11 165 412,500.00
96 Omeprazol Kaps 20 mg Kapsul 130.00 405 6,075 789,750.00
97 Parasetamol sirup 120 mg/5 ml btl/60 ml 1,107.00 187 2,805 3,105,135.00
98 Paracetamol drops 10 mg/ml Btl/15 ml 6,649.00 34 510 3,390,990.00
99 Parasetamol tablet 500 mg tablet 53.00 9,976 149,640 7,930,920.00
100 Pirantel tab 125 mg tablet 289.00 - -
101 Piridoksin (Vit B 6) tablet 10 mg tablet 123.00 1,477 22,155 2,725,065.00
102 Prednison Tablet 5 mg tablet 68.00 347 5,205 353,940.00
103 Propanolol tab 10 mg (HCl) Tablet 54.00 - -
104 Ranitidin tab. 150 mg tablet 105.00 2,368 35,520 3,729,600.00
105 Retinol (Vit A) 100.000 IU Kaps lunak Kapsul 288.00 390 5,850 1,684,800.00
106 Retinol (Vit.A) 200.000 IU Kaps lunak kapsul 517.00 1,935 29,025 15,005,925.00
107 Ringer Laktat Larutan Infus Steril Btl/ 500 ml 7,150.00 - -

108 Salbutamol 2 mg tablet 63.00 128 1,920 120,960.00

109 Salbutamol tablet 4 mg tablet 70.00 - -
110 Salbutamol sirup 2 mg/ml Btl/100 ml 4,446.00 -
111 Salep 2-4 , kombinasi : Asam salisilat 2% + Pot 2,621.00 4 60 157,260.00
Belerang endap 4%

112 Sefiksim 100 mg (untuk program) Kapsul 803.00 - -

113 Sianokobalamin (Vit. B12) tab. 50 mcg tablet 46.00 606 9,090 418,140.00
114 Simvastatin tablet 10 mg tablet 110.00 495 7,425 816,750.00
115 Simvastatin tablet 20 mg tablet 205.00 770 11,550
116 Siprofloksasin tablet 500 mg tablet 265.00 677 10,155 2,691,075.00
117 Scabimite cream 5% 10 gr/ tube 12,155.00 2 30 364,650.00
118 Tablet tambah Darah kombinasi (Besi II sulfat Tablet 353.00 1,926 28,890 10,198,170.00
200 mg + Asam folat 0,25 mg)(Ferro folat)

119 Tiamin HCl/Nitrat (Vit B1) tab 50 mg tablet 85.00 2,093 31,395 2,668,575.00
120 Trihexipenidil tab. 2mg Tablet 85.00 - -
121 Vitamin B kompleks tablet tablet 83.00 1,585 23,775 1,973,325.00
 KEBUTUHAN KEBUTUHAN
NAMA OBAT SATUAN HARGA SATUAN PERBULAN SETAHUN (15 Bl) TOTAL HARGA

1 2 3 4 5 6=5*15bln 7=6*5
122 Zink tab 20 mg tablet 524.00 79 1,185 620,940.00
123 Zink sir 20 mg/5 ml / ZIRKUM btl/60 ml 2,972.00 42 630 1,872,360.00

B.OBAT INJEKSI
1 Asam Traneksamat 5% injeksi vial 2,445.00 - -
2 Atropin injeksi ampul 1,748.00 - -
3 Benzatin Benzil Penisilin injeksi vial 14,500.00 - -
4 Budesonid 0,25 mg/ml / PULMICORT respules 9,725.00 - -
5 Deksametason inj 5 mg/ml ampul 1,097.00 - -
6 Epinefrina (adrenalin) injeksi 0,1% (sbg HCl) Ampul 1,408.00 - -

7 Fitomenadion (Vit K1) Injeksi 10 mg/ ml- 1 ml ampul 3,682.00 - -

8 Glukosa kalsikus injeksi 10% Ampul 7,800.00 - -
9 Hyosina N. Butilbromida 20 mg/ml Ampul 17,500.00 - -
10 Lidokain Komp. Injeksi, Kombinasi: Ampul 1,152.00 12 180 207,360.00
11 Magnesium sulfat injeksi 20% Vial 3,796.00 - -
12 Ranitidin inj. 25mg/2 ml Ampul 1,155.00 - -
13 Oksitosin injeksi ampul/2,5 1,199.00 1 15 17,985.00
ml
14 Ipratropium br 0,5 mg+ salbutamol 2,5 mg vial 4,550.00 - -
inhalasi /COMBIVENT

C.OBAT LUAR
1 Etakridin (Rivanol) larutan 0,1 % Btl/300 ml 3,000.00 2 30 90,000.00
2 Etanol 70 % Btl/1000 25,000.00 2 30 750,000.00
ml
3 Hidrogen peroksida 3% Btl/1000 30,000.00 - -
ml
4 Jelly 80 g untuk USG/Doppler tube 29,549.83 1 15 443,247.45
5 Lisol mengandung Kresol Tersabun 50% Btl/1000 41,000.00 2 30 1,230,000.00
ml
6 Povidon Iodida 10% Btl/60 ml 3,700.00 7 105 388,500.00

OBAT GIGI
1 Eugenol - 10ml Btl/10 ml 18,824.00 2 30 564,720.00

II OBAT-OBAT NON E KATALOG

1 Ambroksol sirup 15 mg/ 5 ml btl/60 ml 5,214.00 132 1,980 10,323,720.00
2 Ambroksol tablet 30 mg tablet 179.17 2,636 39,540 7,084,381.80
3 Asiklovir Krim 5%- 5 g tube 3,382.00 20 300 1,014,600.00
4 Antiinfluensa tab dewasa (kombinasi tab 397.00 573 8,595 3,412,215.00
paracetamol, fenilpropanolamin dan ctm)
5 Boraks Gliserin Btl/10ml 3,500.00 29 435 1,522,500.00
6 Gliseril Guayakolat Tablet 100 mg Tablet 108.00 593 8,895 960,660.00
7 Hyosin Butilbromid Tab 10 mg tablet 1,941.00 - -
8 Ichtyol salep 10% Pot 15g 5,500.00 6 90 495,000.00 * dibeli dinas
9 Kloramfenikol Tetes Telinga 1% Btl 7,000.000 23 345 2,415,000.00
10 Nifedipin tab 10 mg tablet 129.00 - -
11 Natrium Bikarbonat tab 500 mg Tablet 65.00 - - * dibeli dinas
12 Salisil Bedak 2% Kotak 50 gr 2,500.00 94 1,410 3,525,000.00
13 Obat Batuk Herbal mengandung : zingiberis Btl/100 ml 12,000.00 116 1,740 20,880,000.00
Offinale rhizoma,/zingeberis
Rhizoma/HERBAKOF
14 Obat batuk kombinasi untuk anak (kombinasi btl/60 ml 7,000.00 163 2,445 17,115,000.00
paracetamol, GG dan ctm)
15 Multivitamin sirup Btl/60 ml 6,000.00 62 930 5,580,000.00
16 Multivitamin tablet Tab 600.00 408 6,120 3,672,000.00
17 Paracetamol suppos 125 mg ktk/dus 17,600.00 3 45 792,000.00
18 Salep luka bakar Pot 15g 4,125.00 8 120 495,000.00
19 Triamsinolon oral base krem 5 g Tube 5 g 18,920.00 21 315 5,959,800.00

OBAT GIGI
1 Devitalisasi pasta btl 244,200.00 1 15 3,663,000.00

2 Temporary anestesi buat gigi semprot (bahan btl/200 ml 352,000.00 2 30 10,560,000.00

dasar: butan, propan, iso butan) capilary tube
10 cm

3 Glass Ionomer Cement ART (GC-IX)/ Fuji IX Botol/ 10 g 700,000.00 2 30 21,000,000.00

 KEBUTUHAN KEBUTUHAN
NAMA OBAT SATUAN HARGA SATUAN PERBULAN SETAHUN (15 Bl) TOTAL HARGA

1 2 3 4 5 6=5*15bln 7=6*5
4 Kalsium hidroksida pasta 2tube/ktk 191,400.00 - -
5 Klorfenol Kamfer Mentol (CHKM) Btl/10 ml 72,600.00 1 15 1,089,000.00

6 Bahan Tumpat sementara pot/30g 190,000.00 - -

TOTAL NILAI KEBUTUHAN - 333,116,892.15

Bekasi, ....................................
Mengetahui
Pengelola Obat Kepala Puskesmas

.......................................... .................................
NIP. .................................... NIP. .............................
* dibeli dinas

* dibeli dinas
A. Stok opname obat dan BMHP
1 Laporan Stok Opname obat dan BMHP dilaporkan oleh 39 Puskesmas induk
2 Stok opname dilengkapi dengan Berita Acara Stok Opname Obat dan BMHP
3 Petugas hanya mengisi jumlah stok pada kolom 6 dengan memperhatikan
Sumber anggaran barang karena mempengaruhi nilai barang
4 Kadaluarsa barang agar dicantumkan pada kolom 8
5 Barang yang tidak tertera pada format / harga berbeda agar dicantumkan
pada kolom TAMBAHAN
6 Agar dipastikan laporan stok opname ini nilainya sama dengan
Laporan persediaan barang pada bendahara barang Dinas Kesehatan
7 Laporan Stok opname paling lambat kami terima tanggal

B. Rencana Kebutuhan Obat dan BMHP

1 Rencana Kebutuhan Obat dan BMHP agar disampaikan oleh 42 Puskesmas
2 Bagi Puskesmas Induk/asal dan Puskesmas Baru agar saling berkoordinasi
untuk menyesuaikan kebutuhan masing-masing
3 Petugas hanya mengisi kebutuhan perbulan pada kolom 6
4 Obat-obat Non E katalog (obat dan obat gigi ) hanya diisi oleh puskesmas non JKN
kecuali untuk obat non katalog yang dibeli dinas kesehatan puskesmas JKN
bisa mengisi
5 Rencana Kebutuhan paling lambat kami terima tangga 14 Desember 2018

TTD
Kasi. Kefarmasian